September 2006

Special Theme: Highlights of the Meeting

This article is the text of the speech Dr Gold gave at the June, 2006 NAAHP Meeting in which she calls for the help of pre-health advisors to help in the selection of humanistic doctors. The educational system is already set up to select for students with academic strengths, especially in the sciences, but Dr Gold believes that the medical profession should demand students who also demonstrate such characteristics as integrity, compassion, and empathy. Speaking on behalf of the Gold Foundation, she noted that humanistic skills may be taught, mastered, and measured. The mission of the Foundation is to advocate for humanistic patient care, and to that end, it supports rituals as the White Coat Ceremony, recognition in the form of awards for outstanding humanistic practice, and support for curriculum development to help medical students develop humanistic attitudes.

Dr Gold then turned her attention to identifying ways in which pre-health advisors could help their students develop empathy, professionalism, and compassion in their undergraduate years. She suggested six specific ideas for advisors to try. First, students should be encouraged to learn about the human condition through art, literature, history, and the study of the humanities and social sciences, in general. Next she urged advisors to recommend or even require students to participate in service programs in order to develop a life-long commitment to service. She suggested exposing students to speakers who embrace humanistic values in their practice, and, as a follow up, to have students shadow these practitioners, preferably over a period of time. It is important for students to understand the life of a physician and to clarify the commitment one makes when entering the field. Dr Gold also recommended exposing students to patient stories by having them hear the stories of real people. Finally, she asked advisors to encourage their students to accept responsibility for the care of the entire population, not just their particular patients. Students need to develop knowledge and leadership skills to help them improve public health, advocate for better policies and legislation, and to become agents of change. By encouraging undergraduates in these ways, advisors will help set their students on the “right path” to the practice of medicine.

The authors offer an overview of the current physician workforce as well as future needs. Several major reports call for a substantial increase in the physician workforce over the next 10 – 15 years as a result of the following factors: an increase in the U.S. population, a doubling of the number of citizens over the age of 65, a continuing rise in expectations for health care, an aging physician workforce, and a new generation of physicians with different practice expectations, including fewer hours than their predecessors. In addition to the overall shortage, eleven specialties have reported shortages.

The commonly accepted solution to this problem is the expansion of medical education in the forms of increased class size and the addition of new medical schools. Because medical training is such a lengthy process, it would take at least 10 years to begin to see the number of practicing physicians increase. Some of the barriers to increasing enrollment size include expansion costs, scholarship availability, space constraints, availability of preceptors and training sites. Already in response there are plans for five allopathic and six osteopathic schools to open in the next several years. Another option for increasing the workforce is expansion through regionalization of medical education. This alleviates the space issues, while conserving curricular and administrative costs. Regional or branch campuses have been opened by both allopathic and osteopathic schools. Another option for expansion is medical training for specific specialties or types of practice. Such a program would attract potentially a different group of applicants that might otherwise seek advanced education elsewhere.

One of the challenges to expanding medical education is maintaining a qualified applicant pool. Another is maintaining the quality of medical education as defined by the accrediting bodies of allopathic and osteopathic medicine. To address the former challenge, programs are underway such as aspiringdocs.org, an effort that targets underrepresented populations. It is clear that standards will not be compromised in any expansion effort. Additional considerations to provide quality care to a greater number of people include the use of technology, the use of physician extenders, an increase in scholarships, and the expansion of loan repayment programs. The solution, like the problem, is likely to be complex, employing the use of a variety of methods.

In response to the significant rise in the number of dental school applicants (67% from 2001 to 2006), the authors have provided the answers to many common questions about the desired attributes of candidates for dental school. Academic preparation is important and, although a biology major is generally not necessary, upper level biology courses are recommended. Strong candidates demonstrate good time management skills, strong ethical behavior, and a clear understanding of the field. Shadowing, work, and volunteering demonstrate knowledge of the field. Students are encouraged to spend time with a general dentist even if they desire a specialty for a career. Good hand-eye coordination may be developed through art courses, hobbies, and other activities. Applicants who have overcome challenges and applicants whose career goals match those of the school are looked upon with favor.

Tables are presented to show competitive GPAs and DAT scores. Students are advised to take the DAT in the late spring of their junior year and to plan to take the test only once (although up to three tests are allowed). Applications should be submitted as early as possible and should address clearly the reasons for choosing dentistry as a career. Older applicants are welcomed, as are dental hygienists with strong academic backgrounds. Applicants whose early academic careers were poor may be viable candidates if there is significant improvement. Misconduct at the undergraduate level must be adequately explained. Academic enrichment programs, formal or self designed, are encouraged for disadvantaged students. Community college courses may be cause for concern unless taken for good reasons. Re-applicants should apply early, demonstrate improvement from the first application, and should have a Plan B. Red flags include light course loads without good reason, too many course withdrawals, too many schools attended, and “helicopter parents”. Advisors are encouraged to consult the ADEA publications, as well as the ADEA.

This article summarizes a panel discussion about how advisors can help applicants address sensitive issues, in particular, LGBT, religious, and political issues. Advisors are often privy to very personal information and are in a position to help students articulate their personal struggles and beliefs.

If applicants opt to write about such issues in their personal statement it is important to remind them to consider tone and audience. The personal statement is not a good place to argue a controversial or sensitive topic. The focus should be on linking their issue to the broader topic of the practice of medicine. The reader (audience) should be able to understand clearly why they are reading about the issue. Useful directions to take such issues include how it has shaped the applicant, how dealing with the issue will influence their future medical practice, and how it might inform medical school classmates. Care should be taken not to appear intolerant or to portray one’s self as a victim.

In broader terms, it was suggested that advisors guide students about how much to reveal based on their comfort level in discussing their beliefs or situation. If an issue is discussed in the personal statement, it becomes fair game for discussion during an interview. Applicants should research their schools carefully to determine how supportive the institution will be to their situation. Suggested resources for such information include mission statements, EOE statements, religious affiliations, availability of student groups, and the tolerance of the surrounding community. Comfort level with discussing their needs should also dictate whether applicants explore the issue during their interview day or after receiving acceptance.

In summary, it is important for the applicant to portray their true self. Keeping a personal issue personal is fine, but no one should try to be someone counter to their values and beliefs. The “fit” is important for both the applicant and the school.

Two veteran advisors offered three common scenarios that put advisors on the defensive and gathered suggestions for response and prevention of the various issues.

The first involved a new administrator who does not understand the need for a pre-health advisor. Consensus was that lack of knowledge is the problem and education is the answer. Documentation in the form of annual reports and weekly logs would be especially useful. Education might also include noting the importance in cultivating relationships with professional schools, describing their role as buffer between parents and administration, noting the additional burden that would be placed on faculty, and emphasizing the role that advising plays in admissions and recruitment efforts, pointing to comparison schools, if necessary.

The second scenario involved a nontenured faculty advisor whose department chair suggests that advising duties might interfere with getting tenure. The consensus was that the person should first obtain tenure, putting advising aside if necessary, and return to advising after being granted tenure.

In the third scenario, the advisor’s job responsibilities have grown, but the job description and salary have stayed the same. There was agreement that the advisor should ask for more money or release time. Providing documentation as described in the first scenario is a good strategy to use. In all cases, being proactive in letting supervisors know what is involved in the job is a good preventive measure to take.

Hot TopicsKaren deOlivares, Ph.D.

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